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The rock musician and composer Frank Zappa once said that there were two substances that you could not overdose on: sex and vegetables. So let me ease my way into the rather titillating topic of foot orgasms by telling you about referred pain and dropping in a public health message at the same time.

Back in medical school I got taught referred pain via the example of heart attacks leading to a pain in the left arm or shoulder.

As you know, the heart is a hollow, muscular organ that pumps about five litres of blood each minute. And if one day you do have a heart attack, the problem is that the muscles that do the pumping don't get enough oxygen and they can complain. They complain not by getting a pain in the heart, but by a pain felt in the left arm or shoulder. This is classic referred pain, where the pain coming from an internal organ, the heart, is shifted or referred to an external location, the left arm or the shoulder. (By the way, a heart attack is a genuine and serious medical emergency, and if someone ever has symptoms suggesting a heart attack, they should ring the emergency medical services immediately).

Now we don't really understand the mechanism by which referred pain happens, but one reasonable theory runs like this:

The heart sends sensory information to your brain via some relay stations at the top of your spinal cord. By coincidence your left arm and shoulder also use those very same relay stations to send sensory information to the brain. For most of your life, your heart never complains. And over a lifetime your brain gets used to the idea that any sensations coming from those relay stations at the top of your spinal cord are coming from your left arm. So one day, when your heart finally does complain, your brain sticks to what it knows and interprets this unfamiliar situation of a heart attack as pain in your left arm.

The foot orgasm situation that was first described in 2013 is a kind of reversed referred pain.

Sensation from an external location, in this case the left foot of a 55-year-old woman is interpreted as sensation coming from the internal genital area.

Getting back to basic neuroanatomy, both the foot and the genitals share the same relay stations down at the bottom of her spinal cord. In other words, sensation on the bottom of her foot would lead to an orgasm. The result was spontaneous, unwanted, and yes, inconvenient sexual orgasms with absolutely no sexual desire or arousal.

They were different from the woman's regular orgasms in that they occurred very suddenly without any pre-orgasmic build up, were very short— lasting only five or six seconds — and finished in a very uncharacteristic and abrupt manner. She would need a few minutes to recover. This happened five or six times each day often accompanied by vaginal lubrication.

The story began in 2008 when this woman had an operation on her gall bladder. There were some unfortunate complications including massive infection and breathing problems so she had to stay in intensive care and the department of surgery for three weeks. She was very unwell. The guess is that at this stage there was some damage to the relay stations at the bottom of her spinal cord.

As a result of the damage she had some strange tingling and burning sensations in her left foot. In June 2010, she was prescribed the SSRI antidepressant paroxetine to try to relieve the abnormal foot sensations.

You might remember that paroxetine was the subject of some court actions and also has a whole range of side effects, some of them a little bizarre.

In the case of our 55-year-old woman, the foot orgasms began within a few days of starting taking paroxetine. We don't fully understand the mechanism, but maybe taking the powerful serotonin-acting drug while the nerve endings in her damaged nerve roots were still trying to heal caused some kind of cross wiring.

One year later she sought medical treatment, even though she was deeply embarrassed and crying uncontrollably. After a lot of work the medicos tried injecting anaesthetic into the left S1 dorsal root ganglion at the base of her spinal cord. This reduced the frequency of the foot orgasms by 50 per cent and their strength by 80 per cent. When they went further and combined the anaesthetic with pulsed radiotherapy treatment the foot orgasms stopped entirely.

So if you start experiencing unwanted and inconvenient orgasms perhaps you should tread carefully …

Comments (13)

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Dann :

09 Apr 2014 12:34:25pm

The sentence "For most of your life, your brain never complains" in the fifth paragraph should probably be "For most of your life, your HEART never complains".

I've sometimes noticed that if I scratch myself in certain places, I'll feel a phantom sensation in a second part of my body as well, as if that location was also being stimulated. The sensation in the second location isn't quite the same though - it's less locationally specific, so manafests as a vague tingling sensation over a larger area of skin. Could this be an example of refered 'sensation' (rather than 'pain')?

There is also a supposed remedy for toothache that involves placing an ice cube against the webbing between the base of the thumb and forefinger. I have no idea whether there's any validity to it though. It might simply be a distraction technique.

SeeEye :

Julian :

Jamie Turnbull :

09 Apr 2014 8:31:35pm

Thank you Dr Carl for an intriguing insight of cross causal happenings, with a hint of adult content.The human body is amazing and it's ability to regenerate, sometimes with a referred great human interest may lead to find new and adventurous ways for human to reach the higher place when sharing good times.Thank you for you marvellous cander and curiosity to bring us such a titillating article.

cicero :

09 Apr 2014 8:39:21pm

If there are symptoms suggesting a heart attack the phone call should be made to the Ambulance Service (in NSW - I am not sure of the resources in other states). Some of the ambos are fitted to conduct tests, (I think it is ECG) which will disclose whether there is an event, the ambos are then wired up to get a cardiac unit ready upon arrival at hospital. It may be advisable for people to inform themselvesof the local ambo services available

Andrew :

10 Apr 2014 8:54:31pm

I worked in the operating theatre for a while. When prepping a perineum for surgery (cold topical stimulus) the toes flex. I've had an itchy bottom sometimes (quite common in the general population but not discussed). You cannot scratch your bottom without wriggling your toes. Interesting neural feedback.

Dutchie :

David in sydney :

11 Apr 2014 9:33:50am

When I was 14 or 15 a friend announced that as he scratched his navel, he had a sensation in his old fellah. We all tried it and out of five or six, a couple had the same experience, but not me. Whether suggestion played a part I don't know, but perhaps there is a circuit involved there too.

DrWho :

07 May 2014 7:38:47pm

Hi Davis

the nerves for the belly button and genitals are quite distinct. But there is a physical connection between the belly button and the bladder. At the other end of the bladder is "the old fella". This more aabout physical stimulation rather than referred sensation.